Estimated Resting Metabolic Rate and Body Composition Measures Are Strongly Associated With Diabetic Retinopathy in Indonesian Adults With Type 2 Diabetes Diabetes Care 2018;41:2377–2384 | https://doi.org/10.2337/dc18-1074 OBJECTIVE To investigate the associations of estimated resting metabolic rate (RMR), body fat (BF), subcutaneous fat (SCF), visceral fat (VF), fat-free mass (FFM) percentage, BMI, and waist circumference (WC) with diabetic retinopathy (DR) in Indonesian adults with type 2 diabetes. RESEARCH DESIGN AND METHODS This was a community-based cross-sectional study of 1,184 subjects with type 2 diabetes. DR was assessed from fundus photography and categorized as mild, moderate nonproliferative DR (NPDR), and vision-threatening DR (VTDR). RMR and body composition parameters were measured using automated body com- position scan. Logistic regression with semipartial correlation analysis was used. RESULTS DR and VTDR were present in 43.1 and 26.3% of participants, respectively. After adjustment for age, sex, diabetes duration, fasting glucose, systolic blood pressure, smoking, diabetic ulcer, and use of combined diabetes treatment, per SD increase in RMR (odds ratio [OR] 2.60 [95% CI 2.19–3.07]; P < 0.001) was associated with DR, while per SD increases in BF (0.66 [95% CI 0.56–0.78]; P < 0.001), FFM (0.69 [0.57– 0.84]; P < 0.001), VF (0.77 [0.67–0.88]; P < 0.001), BMI (0.83 [0.73–0.94]; P = 0.004), and WC (0.81 [0.73–0.91]; P < 0.001) were inversely associated with presence of DR. Similar associations were found for VTDR. Among all variables, RMR had the largest contribution to the variance in the DR model (39%). CONCLUSIONS In this study, RMR and body composition measures were strongly associated with and contributed considerably to the presence and severity of DR. These findings, if confirmed, suggest that RMR and body composition may be strong markers that represent actual metabolic state in the pathophysiology of DR. 1 Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Univer- sitas Gadjah Mada–Rumah Sakit Umum Pusat Dr. Sardjito, Yogyakarta, Indonesia 2 Department of Nutrition and Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia Corresponding author: Muhammad B. Sasongko, mb.sasongko@ugm.ac.id. Received 16 May 2018 and accepted 20 August 2018. This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/ doi:10.2337/dc18-1074/-/DC1. © 2018 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More infor- mation is available at http://www.diabetesjournals .org/content/license. Muhammad B. Sasongko, 1 Felicia Widyaputri, 1 Dian C. Sulistyoningrum, 2 Firman S. Wardhana, 1 Tri Wahyu Widayanti, 1 Supanji Supanji, 1 Rifa Widyaningrum, 1 Sarah R. Indrayanti, 1 Idhayu A. Widhasari, 1 and Angela N. Agni 1 Diabetes Care Volume 41, November 2018 2377 PATHOPHYSIOLOGY/COMPLICATIONS